PREDICTORS OF EARLY VARICEAL REBLEEDING IN LIVER CIRRHOSIS

Abstract

Aim Despite recent great progress, higher rates of variceal rebleeding still occur in cirrhotic patients. In order to increase the survival of these patients, it is necessary to optimize the treatment and follow-up of rebleeding and to correct the risk factors that may increase early rebleeding. In this respect, we evaluated the patients' most relevant demographic and routine laboratory features related to variceal early rebleeding. Methods Patients applied to the hospital with variceal bleeding were evaluated for relationship between rebleeding status and erythrocyte suspension needs and laboratory findings as, hemoglobin and platelet level, prothrombine time, creatinine, bilirubin, albumin level and Child-Pugh stage. Results The rebleeding was ascertained in 20 (21%) of our patients during the six week follow-up period after control of the variceal bleeding. In our study, we took into consideration the most relevant routine laboratory and radiological criteria that are closely related to pathogenesis and development of varices and rebleeding in liver cirrhosis. We found that higher Child-Pugh grade, hypo-albuminemia and presence of ascites were significant predictors for variceal rebleeding and other parameters that lower hemoglobin levels were significant predictors. Conclusion The high variceal rebleeding rate could exaggerate the morbidity and mortality burden on cirrhotic patients, so meticulous follow-up is mandatory for those patients to mitigate this complication and increase survival. In summary, after univariate and multivariate analysis of all our potential predictors for variceal rebleeding, we found that the only independent significant predictors were the Child Pugh Grade(p=0,016) and lower hemoglobin levels(p=0,02).